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Thoracoscopic thymectomy using a subxiphoid camera port
A 71-year old female patient was admitted with a pancreatic neck lesion detected by abdominal ultrasound performed for mild epigastric pain she has been suffering from for 3 months prior to admission. Her past medical history is significant for right nephrectomy performed 25 years ago. The patient stated that she had an acquired cystic kidney disease, but no medical records were available to confirm that. A multidisciplinary investigation was performed. Pancreatic protocol CT-scan revealed a 2.5cm hyper-enhancing round-shaped tumor, located within the pancreatic neck. The patient had no carcinoid syndrome, and levels of PNET specific markers (Chromogranin A, NSE, Insulin, 5-HIIA) were not elevated. CA 19-9 and CEA levels were also normal. The tumor was [111In]-octreotide negative on octreotide scan. As a result, a non-functioning pancreatic neuroendocrine tumor was suspected considering its CT-scan characteristics.
A laparoscopic pancreatic enucleation was planned with possible central pancreatectomy in case the enucleation would turn out to be unfeasible. The attempt to perform enucleation failed due to intensive bleeding from an intrapancreatic vessel, unclear borders of the tumor, and high risk of postoperative pancreatic fistula formation. It was decided to continue the surgery with central pancreatectomy.
The postoperative course was complicated by a postoperative pancreatic fistula (POPF) grade B (according to the ISGPF classification), which was managed successfully using interventional percutaneous drainage. Final histopathological examination revealed a clear cell renal cell carcinoma (RCC) metastatic lesion to the pancreas. A CT-scan performed 2 years after the surgery revealed no signs of disease progression. The pancreaticojejunostomy shows no signs of obstruction. The patient has neither exocrine nor endocrine pancreatic insufficiency.
The purpose of the video is to demonstrate the feasibility of laparoscopic central pancreatectomy, which is an organ-preserving procedure and is accompanied with better long-term results.
Laparoscopic central pancreatectomy for renal cell carcinoma metastasis
Laparoscopic Sugarbaker parastomal hernia repair
Laparoscopic treatment of peritonitis after low anterior resection (interactive case)
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